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The 1st Over-the-Counter Birth Control Pill is Now Available. How Does it Work?

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A box of medicine, called Opill in a turquoise case.
Perrigo sells the pills under the brand name Opill. (Courtesy of Perrigo )

Opill — the over-the-counter birth control pill that was approved by the Food and Drug Administration last year — is now available.

This means people now have access to a birth control pill without needing a prescription from a doctor or requiring health insurance — making it accessible “over-the-counter,” like a painkiller like Tylenol.

“I think it’s really important for people to know that this is the best, most efficacious method available over the counter,” said Sophia Yen, a clinical associate professor at Stanford Medical School and co-founder of Pandia Health, an organization specializing in reproductive care.

Back in 2019, the American College of Obstetrics and Gynecology recommended that all birth control methods — including the ring, patch, and the pill — should become available over-the-counter, as Opill now is. And now, this pill is becoming readily available at a time when reproductive rights — like access to abortion — have been under legal attacks throughout the country after the Supreme Court overturned Roe v. Wade.

If you are a person who wants to start taking birth control but may not have health insurance or access to a prescriber, keep reading to find out what to know about the over-the-counter birth control pill.

Who can buy Opill, and where is it available?

You can buy Opill in the following ways in California, with no insurance required:

  • Over-the-counter at a pharmacy like Walgreens or CVS.
  • In the family planning aisles of a major retail store (for example, Walmart).
  • Online at opill.com.

There is no age restriction on sales, and the packaging is described by the company as “discreet,” for buyer’s privacy.

According to the manufacturer, you should not use Opill:

  • If you have ever had breast cancer.
  • Together with another birth control pill, vaginal ring, patch, implant, injection or an IUD.
  • If you are allergic to ingredients in Opill (for example, some people allergic to aspirin are also allergic to tartrazine, which is the color additive in Opill).

How much does Opill cost?

According to Opill’s website, a month’s supply retails for $19.99. A three-pack supply of Opill costs around $50, and a six-pack costs $90.

As of August 2023, California passed a law requiring state-regulated private health insurers to cover over-the-counter contraception without a prescription and without cost sharing. But as NPR notes, “not everyone wants their birth control pill to show up on their insurance, so they may choose to pay out of pocket” rather than having insurance cover those costs.

Opill is also eligible for reimbursement through a Flexible Spending Account or Health Savings Account — meaning the money people set aside in their employee benefits can potentially be used to purchase Opill.

There is also a cost assistance program for low-income folks who want to purchase Opill. In order to be eligible for the cost assistance program, a person must:

  • Reside in the United States or its territories, and
  • Not be covered by commercial or public insurance (like Medicaid/Medi-Cal, Medicare, VA health care), and
  • Have a household income at or below 200% of the Federal Poverty Level (For one person, that is at or below $30,120. For a household of two people, it is $40,880.)

How does Opill work to prevent pregnancy?

Opill is a daily progestin-only pill, also known as a “mini-pill.”

Progestin-only pills work by thickening the mucus at the entrance of the uterus so sperm cannot pass through to fertilize an egg and result in pregnancy. Opill takes 48 hours to become effective, so extra protection — such as condoms — should be used for those first two days.

There are a few things to consider about choosing a progestin-only pill like Opill, Yen said. Other prescription birth control pills typically both include estrogen and progestin, and are known as the “combined pill”, because they contain two hormones that prevent the ovaries from releasing an egg each month. This means they are slightly more effective than the progestin-only counterparts like Opill.

Bleeding patterns on the progestin-only pills can also be unpredictable, Yen said. However, some people — like individuals over the age of 35, people breastfeeding, or those who are at higher risk of blood clots — may want to avoid estrogen and, therefore, seek out a progestin-only pill anyway.

Research from Louisiana State University Health Sciences Center has found that when either pill is used perfectly — meaning every day, on time — “less than one woman out of 100 will become pregnant in the first year of use.”

But “perfect” use isn’t always realistic. This is why research notes that the failure rate for “typical use” of combined oral contraceptive pills — that is, pills not always used consistently — is 9% “due to human error.

That means timing is important. A person using birth control pills needs to take one pill at the same time every day for maximum effectiveness at preventing pregnancy — but “any birth control pill has a window of forgiveness,” Yen said.

A combination pill, she explained, has “a 24-hour window of forgiveness, generally.”

“Usually we say: ‘You miss one pill? Take it as soon as you remember it. If you miss three pills, [the] game’s up, and you need emergency contraception.'”

However, a progestin-only pill like Opill has a smaller window of forgiveness because “you don’t have estrogen as the backup” as you do with the combination pill, Yen said, “so the window of forgiveness is three hours, technically.”

But “who hasn’t been late taking their birth control by three hours?” Yen said, acknowledging how unexpected schedule changes or straight-up forgetfulness can impact a person’s pill regimen. If you do find you’re taking your progestin-only pill three hours late or more, “you will need to abstain from sex for at least the next 48 hours,” she recommends, “while the hormone level gets [back] up to a level that can protect you.” Opill’s own FAQs also note that you should “use a condom each time you have sex for the next two days” if you don’t abstain.

What if a person is three or more hours late in taking their pill and they’ve had sex in the past three to five days? Since sperm can live for up to five days, in this case, Yen suggests seeking out emergency contraception as soon as possible.

Often, confusion over when to take birth control can arise when a person is traveling and arriving in a new time zone. In this case, the next pill needs to be taken 24 hours after you last took a pill, advised Yen.

What should I do if I miss the ‘window of forgiveness’ with my birth control pill?

Emergency contraception can prevent 95% of pregnancies within five days of unprotected sex, like a broken condom or missing the window of forgiveness. Options include morning-after pills like Plan B, the copper IUD and the hormonal IUD. You can find a clinic that offers these services using Planned Parenthood’s search tool.

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Yen said emergency contraception that is prescribed “beats any over-the-counter emergency contraception and efficacy at every single time point,” Yen said. “And thanks to the Affordable Care Act, if you have insurance, it’s available with no co-pay, no deductible, aka free.”

However, Yen said a person’s body mass index does factor in whether or not the over-the-counter emergency contraception is effective. For example, if a person’s BMI is greater than 26 — a medication like Plan B may not work as well. If it is greater than 30, Yen said, it “doesn’t work at all.”

Yen said Ella — a prescription emergency contraception (also known as a “morning-after pill”) — is effective with BMIs up to 35. Planned Parenthood has a quiz for people to see which method of emergency contraception could work for them.

Can a birth control pill prevent STIs?

No, pills cannot prevent sexually transmitted infections.

If a person is aged 12 to 19 in California, the Condom Access Project has a search tool to find free condoms.

You can also get condoms in the San Francisco City Clinic, which provides low-cost STI testing. Free or low-cost condoms are also available at the Public Health Division on Van Ness Avenue.

Your county may also provide free condoms as Santa Clara County does at the Crane Center.

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